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1.  A randomized clinical trial using an educational intervention demonstrated no effect on interobserver agreement on assessments of functional status 
Archives of Public Health  2009;67(3):128-141.
To evaluate the effect of an educational intervention on interobserver agreement of assess-ments of functional status performed by registered nurses and care assistants in a nursing home and to compare interobserver agreement in persons with and without cognitive impairment.
High accuracy of assessments of functional status in care settings for older persons is needed for the efficacy of the planning and the evaluation of the nursing care.
Randomized clinical trial. Six registered nurses and six care assistants were randomized to participate in an educational session about assessment instruments for functional status (intervention) or in a session about falls in the elderly (control). Each of the registered nurses and care assistants performed assessments on the same thirty-four residents using the Belgian Evaluation Scale (BES) and the AGGIR instrument. The kappa statistic (κ) for multiple observers (and its 95% confidence interval) was the main outcome measure.
At baseline, interobserver agreement for BES total score was: κ = 0.43 (0.35-0.51) in the intervention group and κ = 0.48 (0.39-0.57) in the control group. At the second assessment, agreement measures were: κ = 0.48 (0.41-0.57) in the intervention group and κ = 0.58 (0.50-0.66) in the control group. Results for AGGIR total scores were similar.
Interobserver agreement of assessments on nursing home residents was moderate and did not improve significantly after an educational session.
PMCID: PMC3463016
Assessment; nursing; nursing home; reliability; randomized clinical trial; Belgian Evaluation Scale; Autonomie Gérontologie Groupe Iso-Ressources (AGGIR)
2.  Progression and improvement after mild cognitive impairment 
Archives of Public Health  2009;67(1):7-14.
We studied progression to dementia and improvement rates of mild cognitive impairment (MCI) to help clinicians decide whether or not to screen older people for MCI.
Prospective cohort study in which 156 vulnerable patients with (n = 24) and without (n = 132) MCI are followed and reassessed after two years with MMSE and Camdex.
Nine (38%) out of 24 patients initially diagnosed with MCI and 20 (15%) out of 132 considered normal or depressed progressed to dementia within two years. This results in a relative risk of progression of 2.48 (95% confidence interval = 1.29-4.77), a sensitivity of 31%
(95%CI = 16-51) and a predictive value of 38% (95%CI = 20-59). Out of 24 people with MCI at baseline, 8 (33%; 95%CI = 16-55) had improved at follow-up.
The low sensitivity of MCI for subsequent occurrence of dementia and the high improvement rate found in our study as well as by others, and the absence of a proven therapy, provide cumulative evidence against screening for MCI.
PMCID: PMC3436696

Results 1-2 (2)